Liu Wen-Jing, Hu Wen-Yu, Chiu Yie-Fong, Chiu Tai-Yuan, Lue Bee-Hong, Chen Ching-Yu, Wakai Susumn
Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
Support Care Cancer. 2005 Oct;13(10):781-9. doi: 10.1007/s00520-005-0778-7. Epub 2005 Feb 22.
To identify the willingness, influencing factors, and educational needs of community physicians in providing palliative care in the rural areas of Taiwan.
A questionnaire was sent to all medical directors of the 140 government health stations assigned to the rural areas of Taiwan.
The overall response rate was 62.8% with 85 valid questionnaires retrieved. The majority of respondents (84.7%) expressed a willingness to provide palliative care if they encountered an advanced cancer patient. However, they would limit their services to consultation and referral (93.0% and 87.5%, respectively), and were less likely to provide home visits (40.3%) or bereavement support of the family (29.2%). With respect to knowledge, the accurate answers to the philosophy/principles and clinical practice of palliative care were 93.4% and 57.3%, respectively. Regarding attitudes, the highest score item in perceiving the threat about providing palliative care was "uncomfortable to meet and take care of the advanced cancer patient." The highest score item in perceiving barriers was "providing palliative care may shorten patient's life, just like euthanasia." The results of stepwise logistic regression analysis for the willingness to provide home visits showed that only the subjective norms remained in the model (OR = 1.87, 95% CI = 1.17-3.01). Educational needs expressed by the respondents were ranked as follows: emotional support to, communication skills with, and bereavement support for the advanced cancer patients and their relatives.
Effective training courses that emphasize the practical knowledge of palliative care for community physicians, incorporating palliative care into medical education particularly in terms of communication skills and ethical roles, and active health policy administration including insurance payments, are important for the enhancement of community palliative care in Taiwan.
确定台湾农村地区社区医生在提供姑息治疗方面的意愿、影响因素及教育需求。
向台湾农村地区140个政府卫生站的所有医疗主任发放问卷。
总体回复率为62.8%，共收回85份有效问卷。大多数受访者（84.7%）表示，如果遇到晚期癌症患者，他们愿意提供姑息治疗。然而，他们会将服务限于咨询和转诊（分别为93.0%和87.5%），较少愿意提供家访（40.3%）或对患者家属的丧亲支持（29.2%）。在知识方面，对姑息治疗理念/原则和临床实践的正确回答率分别为93.4%和57.3%。在态度方面，在感知提供姑息治疗的威胁方面得分最高的项目是“会见和照顾晚期癌症患者感到不舒服”。在感知障碍方面得分最高的项目是“提供姑息治疗可能会缩短患者生命，就像安乐死一样”。对家访意愿进行逐步逻辑回归分析的结果显示，模型中仅保留了主观规范（OR = 1.87，95% CI = 1.17 - 3.01）。受访者表达的教育需求按以下顺序排列：对晚期癌症患者及其亲属的情感支持、沟通技巧和丧亲支持。
为社区医生提供强调姑息治疗实用知识的有效培训课程，将姑息治疗纳入医学教育，特别是在沟通技巧和伦理角色方面，并实施包括保险支付在内的积极卫生政策管理，对于加强台湾的社区姑息治疗很重要。
